Determinants of participation in leisure activities among adolescents with cerebral palsy
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Studies have identified restrictions in engagement in leisure activities for adolescents with disabilities. Participation is a complex construct and likely influenced by a variety of factors. These potential determinants have not yet been sufficiently explored in the population of adolescents with cerebral palsy (CP). The objective of this study is to estimate the potential influence of adolescent characteristics and environmental factors as determinants of participation in leisure activities for adolescents with CP. A cross-sectional design was used. Participants were adolescents (12-19 years old) with cerebral palsy. Participants were assessed with the Vineland Adaptive Behavior Scale - II, Gross Motor Function Measure, Gross Motor Function Classification System, Manual Ability Classification System and completed the Self-Perception Profile for Adolescents, Dimensions of Mastery Questionnaire, Strengths and Difficulties Questionnaire, Family Environment Scale, the European Child Environment Questionnaire and the Preferences for Activities of Children. The main outcome measure was the Children's Assessment of Participation and Enjoyment. 187 adolescents (age M=15.4; SD=2.2) completed the study. Multivariate models of participation in leisure revealed associations with factors related to the adolescents' functional characteristics and attitudes, the family environment, socioeconomic status, and contextual factors such as school type, and collectively explained from 28% (diversity of skill-based activities) up to 48% (intensity and diversity of self-improvement activities) of the variance in intensity and diversity in five leisure participation domains (diversity: r(2)=.33 recreational; r(2)=.39 active-physical; r(2)=.33 social activities). Adolescent's mastery motivation, self-perception and behavior were individually associated with participation in different activity domains, but did not strongly predict participation within multivariate models, while preferences for activities were strong predictors of participation in all domains, except for skill-based activities. Engagement in different types of leisure activities is important for adolescents' development and well-being. Health care professionals should consider adolescents' and families' characteristics to promote participation in leisure activities.